NPIMap

Organization Active NPI

Grace Shores Recovery, LLC

  • Clinical Medical Laboratory
  • Costa Mesa, CA
National Provider Identifier
1942656954
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
05D2080278 Issued in CA
Legal business name
GRACE SHORES RECOVERY, LLC
Practice address
2554 Elden Ave
B103
Costa Mesa, CA 92627-5127
Phone
(949) 220-3770
NPI assigned
May 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rebecca Edge
Title
Founder/Director
Phone
(949) 220-3770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 05D2080278 CA Primary

Addresses

Primary practice location

2554 Elden Ave
B103
Costa Mesa, CA 92627-5127

Mailing address

2554 Elden Ave
B103
Costa Mesa, CA 92627-5127
Phone (949) 220-3770

National Provider Directory

National Provider Directory
Tax ID family
Grace Shores Recovery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462752000000",
    "number": "1942656954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2554 ELDEN AVE",
            "address_2": "B103",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926275127",
            "telephone_number": "949-220-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2554 ELDEN AVE",
            "address_2": "B103",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926275127",
            "telephone_number": "949-220-3770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE SHORES RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-09",
        "last_updated": "2016-05-09",
        "status": "A",
        "authorized_official_last_name": "EDGE",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "FOUNDER/DIRECTOR",
        "authorized_official_telephone_number": "949-220-3770"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05D2080278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.